Reducing PCOS Symptoms With a Low-Carb Diet

For women affected by polycystic ovarian syndrome (PCOS), changing to a ketogenic diet to reduce insulin levels may improve fertility. PCOS is a common disease that affects women in their childbearing age and includes irregular periods and high androgen levels combined with weight problems.

The ketogenic diet is a restrictive low-carb diet plan that focuses on low carbs, low fats and a normal amount of proteins. Patients often see weight loss results—which helps reduce PCOS symptoms—but women with PCOS see improvements because the problem in PCOS is carbohydrate/insulin resistance. “The link between insulin resistance and PCOS is very well studied,” says Ula Abed Alwahab, MD, an endocrinologist at Cleveland Clinic. “If we are able to control insulin resistance, then we are able to reduce many of the PCOS symptoms and complications, including weight, diabetes, high blood pressure, heart disease, and infertility.”

Fixing the problem rather than alleviating symptoms

Dr. Abed explains that the traditional treatment route for PCOS is essentially to treat the symptom. If a patient has irregular periods, her doctor would treat her with birth control pills just to her regular period without focusing on the consequences of that, or how much weight she might gain. If the patient has infertility, she would be given fertility treatments even though they are not always successful because of the other problems associated with PCOS. Dr. Abed’s team aims to achieve all of the goals of women with PCOS, such as weight loss, regular periods or pregnancy with higher success rates. “We’re helping with weight,” says Dr. Abed. “But we are also trying to regulate periods without necessarily being on birth control pills, and to achieve pregnancy and eventually live birth with minimal complications.”

While diabetes medications have been used in the past to treat PCOS, most of these medications return only varying success. However, Dr. Abed notes that after her team saw improvement among her diabetes patients after they began following the ketogenic diet, they decided to explore if the same benefits with insulin resistance could work with their PCOS patients. “We started putting women who have PCOS and are overweight, or obese, on the ketogenic diet,” explains Dr. Abed. “We followed them through shared medical appointments every month. The patients meet with me and a dietician, and we follow their progression.”

The treatment plan

Dr. Abed explains that when she meets with a patient with PCOS, with a BMI more than 30 and is trying to control the symptom or wants to become pregnant, starting the patient on a ketogenic diet is the first option given. The patient comes back for a monthly shared medical appointment. Dr. Abed says, “We start the session with a dietitian piece about women’s health, diet, exercise, lifestyle; it changes every month, and our dieticians work really hard every month to create a 20-minute discussion. After those first 20 minutes, we go around the table and I talk to each patient and address their issues individually, and I see where they are at in their progress. People really enjoy the experience and they get way more benefit from doing the shared medical appointment than just talking to me one-on-one.”

Dr. Abed says the results so far have been very good. Because they are being put on a restricted diet, her patients have been losing weight. Many of her patients are also reporting regular periods again. “We are seeing that many of our patients who are interested in pregnancy are now able to achieve pregnancy,” says Dr. Abed. “Some are even able to achieve pregnancy without medications. These are patients who have struggled with pregnancy, and now we are seeing them able to achieve pregnancy and eventually a live birth. That’s what we’re aiming for with this program—to get a live birth successfully with the program.”

Research and next steps

Dr. Abed and her team are in the midst of a follow-up study to their earlier study that looked at the impact of the ketogenic diet on four women with PCOS. The follow-up study will include a larger patient sample, although Dr. Abed has said she would also like to conduct a study to look at how other low-carb diets, such as the Mediterranean diet, benefit patients with PCOS. The present study includes 35 patients—up from eight patients in the original study. Dr. Abed says she is seeing results similar to the original study, and they are seeing positive results of the ketogenic diet’s effect on PCOS, in terms of infertility. She anticipates that the research will be submitted for publication before the end of the year.

“PCOS is a disease that is not curable, but it’s very well treatable with changing lifestyle,” says Dr. Abed. “The answer is not always in a pill or in a hormonal pill, sometimes it’s just a matter of the patient changing her lifestyle to really improve her symptoms. Our goal is really to achieve each patient’s goals with minimal complications, more success and help them reach a better quality of life.”